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2Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, NSW 2006, Australia

3School of Public Health, University of Sydney

4Screening and Diagnostic Test Evaluation Program, School of Public Health, University of Sydney

Correspondence to: V Entwistle v.a.entwistle{at}dundee.ac.uk

Accepted 21 June 2008

Informed choice is important for screening, but not everyone wants or is able to analyse research data. Vikki Entwistle and colleagues propose a new approach to communication

People are offered a wide range of screening tests by diverse providers. For example: maternal and child health services screen for genetic conditions and developmental problems; general practitioners screen for cardiovascular risk factors; NHS programmes screen for bowel, breast, and cervical cancer; and commercial providers offer various health assessments, including body and gene scans. Provision of tests is not well regulated, and there is a bewildering amount of information of variable accuracy in the public domain.1

It is unclear how healthcare providers should communicate about screening in order to support appropriate uptake. And what constitutes appropriate uptake is also contested because of disagreements about the merits of particular tests and tensions between concerns to promote health and to respect autonomy.234 Debates about communication have tended to consider two types of approach, which we call “be screened’ and “analyse and choose.” We consider their problems and propose a third approach, “consider an offer.”

Be screened

The be screened approach aims to persuade people to have screening, usually with a view to promoting health gain, cost effective service provision, or profit.234 Its key features are encouragement to be screened; an emphasis on the benefits of screening and de-emphasis of potential harms; and a lack of recognition that it might be reasonable not to be screened.

This approach is found in commercial advertisements and some invitations to participate in government funded screening programmes. For example, the leaflet Breast Cancer: the Facts, from the NHS Breast Cancer Screening Programme presents screening as necessary for women aged over 50.5 It asks, “Should all women have breast screening?” and gives no hint of …